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Comparison of the intracorporeal triangular and delta-shaped anastomotic techniques in totally laparoscopic distal gastrectomy for gastric cancer: an analysis with propensity score matching

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Abstract

Background

The delta-shaped anastomotic technique (Delta-SA) has been accepted as a standard reconstruction method in totally laparoscopic distal gastrectomy with Billroth I reconstruction (TLDG B-I). However, some anastomosis-related surgical complications have been reported. We evaluated the safety and feasibility of modified Delta-SA, called intracorporeal triangular anastomotic technique (INTACT), in this study.

Methods

From January 2010 to May 2018, we identified patients who underwent TLDG B-I with INTACT (n = 289) and Delta-SA (n = 221). Using one-to-one propensity score matching, surgical outcomes and gastrointestinal function were compared between the two groups.

Results

After one-to-one propensity score matching, 177 pairs of INTACT and Delta-SA patients were selected. Patient background was closely balanced between the two groups. Operative time (186 [159, 213] min vs. 237 [213, 264] min; P < 0.001), estimated blood loss (0 [0, 10] g vs. 20 [0, 50] g; P < 0.001), and postoperative hospital stay (7 [7, 9] days vs. 10 [9, 13] days; P < 0.001) were significantly lower in the INTACT group than in Delta-SA group. There were no patients with postoperative leakage in the INTACT group and three patients in the Delta group (0.0% vs. 1.7%; P = 0.041). Endoscopic food residue grade ≥ 3 based on the Residue, Gastritis, Bile classification system at 1 year after surgery was observed in 14 patients in the INTACT group and 30 patients in the Delta group (9.6% vs. 17.0%; P = 0.052).

Conclusion

INTACT in TLDG B-I is safe and feasible for gastric cancer. Given its acceptable surgical outcomes, this alternative reconstruction method can be an option with TLDG B-I.

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References

  1. Hu Y, Huang C, Sun Y, Su X, Cao H, Hu J, Xue Y, Suo J, Tao K, He X, Wei H, Ying M, Hu W, Du X, Chen P, Liu H, Zheng C, Liu F, Yu J, Li Z, Zhao G, Chen X, Wang K, Li P, Xing J, Li G (2016) Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial. J Clin Oncol 34:1350–1357

    Article  Google Scholar 

  2. Inaki N, Etoh T, Ohyama T, Uchiyama K, Katada N, Koeda K, Yoshida K, Takagane A, Kojima K, Sakuramoto S, Shiraishi N, Kitano S (2015) A multi-institutional, prospective, phase II feasibility study of laparoscopy-assisted distal gastrectomy with D2 lymph node dissection for locally advanced gastric cancer (JLSSG0901). World J Surg 39:2734–2741

    Article  Google Scholar 

  3. Katai H, Sasako M, Fukuda H, Nakamura K, Hiki N, Saka M, Yamaue H, Yoshikawa T, Kojima K (2010) Safety and feasibility of laparoscopy-assisted distal gastrectomy with suprapancreatic nodal dissection for clinical stage I gastric cancer: a multicenter phase II trial (JCOG 0703). Gastric Cancer 13:238–244

    Article  Google Scholar 

  4. Kim HH, Han SU, Kim MC, Kim W, Lee HJ, Ryu SW, Cho GS, Kim CY, Yang HK, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Hyung WJ (2019) Effect of laparoscopic distal gastrectomy vs open distal gastrectomy on long-term survival among patients with stage I gastric cancer: the KLASS-01 randomized clinical trial. JAMA Oncology

  5. Kanaya S, Gomi T, Momoi H, Tamaki N, Isobe H, Katayama T, Wada Y, Ohtoshi M (2002) Delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy: new technique of intraabdominal gastroduodenostomy. J Am Coll Surg 195:284–287

    Article  Google Scholar 

  6. Kanaya S, Kawamura Y, Kawada H, Iwasaki H, Gomi T, Satoh S, Uyama I (2011) The delta-shaped anastomosis in laparoscopic distal gastrectomy: analysis of the initial 100 consecutive procedures of intracorporeal gastroduodenostomy. Gastric Cancer 14:365–371

    Article  Google Scholar 

  7. Byun C, Cui LH, Son SY, Hur H, Cho YK, Han SU (2016) Linear-shaped gastroduodenostomy (LSGD): safe and feasible technique of intracorporeal Billroth I anastomosis. Surg Endosc 30:4505–4514

    Article  Google Scholar 

  8. Huang CM, Lin M, Lin JX, Zheng CH, Li P, Xie JW, Wang JB, Lu J (2014) Comparision of modified and conventional delta-shaped gastroduodenostomy in totally laparoscopic surgery. World J Gastroenterol 20:10478–10485

    Article  Google Scholar 

  9. Lee HH, Song KY, Lee JS, Park SM, Kim JJ (2015) Delta-shaped anastomosis, a good substitute for conventional Billroth I technique with comparable long-term functional outcome in totally laparoscopic distal gastrectomy. Surg Endosc 29:2545–2552

    Article  Google Scholar 

  10. Matsuhashi N, Yamaguchi K, Okumura N, Tanahashi T, Matsui S, Imai H, Tanaka Y, Takahashi T, Osada S, Yoshida K (2017) The technical outcomes of delta-shaped anastomosis in laparoscopic distal gastrectomy: a single-center safety and feasibility study. Surg Endosc 31:1257–1263

    Article  Google Scholar 

  11. Noshiro H, Iwasaki H, Miyasaka Y, Kobayashi K, Masatsugu T, Akashi M, Ikeda O (2011) An additional suture secures against pitfalls in delta-shaped gastroduodenostomy after laparoscopic distal gastrectomy. Gastric Cancer 14:385–389

    Article  Google Scholar 

  12. Huang C, Lin M, Chen Q, Lin J, Zheng C, Li P, Xie J, Wang J, Lu J (2014) A modified delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric cancer: a safe and feasible technique. PLoS ONE 9:e102736

    Article  Google Scholar 

  13. Omori T, Masuzawa T, Akamatsu H, Nishida T (2014) A simple and safe method for Billroth I reconstruction in single-incision laparoscopic gastrectomy using a novel intracorporeal triangular anastomotic technique. J Gastrointest Surg 18:613–616

    Article  Google Scholar 

  14. Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 14:101–112

    Article  Google Scholar 

  15. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  16. Kubo M, Sasako M, Gotoda T, Ono H, Fujishiro M, Saito D, Sano T, Katai H (2002) Endoscopic evaluation of the remnant stomach after gastrectomy: proposal for a new classification. Gastric Cancer 5:83–89

    Article  Google Scholar 

  17. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4:146–148

    CAS  PubMed  Google Scholar 

  18. Park DJ, Han SU, Hyung WJ, Kim MC, Kim W, Ryu SY, Ryu SW, Song KY, Lee HJ, Cho GS, Kim HH (2012) Long-term outcomes after laparoscopy-assisted gastrectomy for advanced gastric cancer: a large-scale multicenter retrospective study. Surg Endosc 26:1548–1553

    Article  Google Scholar 

  19. Hamabe A, Omori T, Tanaka K, Nishida T (2012) Comparison of long-term results between laparoscopy-assisted gastrectomy and open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surg Endosc 26:1702–1709

    Article  Google Scholar 

  20. Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, Bae JM (2008) Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg 248:721–727

    Article  Google Scholar 

  21. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245:68–72

    Article  Google Scholar 

  22. Kim DG, Choi YY, An JY, Kwon IG, Cho I, Kim YM, Bae JM, Song MG, Noh SH (2013) Comparing the short-term outcomes of totally intracorporeal gastroduodenostomy with extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer: a single surgeon’s experience and a rapid systematic review with meta-analysis. Surg Endosc 27:3153–3161

    Article  Google Scholar 

  23. Kinoshita T, Shibasaki H, Oshiro T, Ooshiro M, Okazumi S, Katoh R (2011) Comparison of laparoscopy-assisted and total laparoscopic Billroth-I gastrectomy for gastric cancer: a report of short-term outcomes. Surg Endosc 25:1395–1401

    Article  Google Scholar 

  24. Komatsu S, Ichikawa D, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Konishi H, Morimura R, Murayama Y, Kuriu Y, Ikoma H, Nakanishi M, Sakakura C, Otsuji E (2015) Clinical outcomes and quality of life according to types of reconstruction following laparoscopy-assisted distal gastrectomy for gastric cancer. Surg Laparosc Endosc Percutaneous Tech 25:69–73

    Article  Google Scholar 

  25. Takiguchi S, Yamamoto K, Hirao M, Imamura H, Fujita J, Yano M, Kobayashi K, Kimura Y, Kurokawa Y, Mori M, Doki Y (2012) A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT. Gastric Cancer 15:198–205

    Article  Google Scholar 

  26. Nakamura M, Nakamori M, Ojima T, Iwahashi M, Horiuchi T, Kobayashi Y, Yamade N, Shimada K, Oka M, Yamaue H (2016) Randomized clinical trial comparing long-term quality of life for Billroth I versus Roux-en-Y reconstruction after distal gastrectomy for gastric cancer. Br J Surg 103:337–347

    Article  CAS  Google Scholar 

  27. Kim MG, Kawada H, Kim BS, Kim TH, Kim KC, Yook JH, Kim BS (2011) A totally laparoscopic distal gastrectomy with gastroduodenostomy (TLDG) for improvement of the early surgical outcomes in high BMI patients. Surg Endosc 25:1076–1082

    Article  Google Scholar 

  28. Lee SW, Tanigawa N, Nomura E, Tokuhara T, Kawai M, Yokoyama K, Hiramatsu M, Okuda J, Uchiyama K (2012) Benefits of intracorporeal gastrointestinal anastomosis following laparoscopic distal gastrectomy. World J Surg Oncol 10:267

    Article  Google Scholar 

  29. Kim BS, Yook JH, Choi YB, Kim KC, Kim MG, Kim TH, Kawada H, Kim BS (2011) Comparison of early outcomes of intracorporeal and extracorporeal gastroduodenostomy after laparoscopic distal gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech Part A 21:387–391

    Article  Google Scholar 

  30. Okabe H, Obama K, Tsunoda S, Tanaka E, Sakai Y (2014) Advantage of completely laparoscopic gastrectomy with linear stapled reconstruction: a long-term follow-up study. Ann Surg 259:109–116

    Article  Google Scholar 

  31. Oki E, Sakaguchi Y, Ohgaki K, Saeki H, Chinen Y, Minami K, Sakamoto Y, Toh Y, Kusumoto T, Maehara Y (2011) Feasibility of delta-shaped anastomoses in totally laparoscopic distal gastrectomy. Eur Surg Res 47:205–210

    Article  CAS  Google Scholar 

  32. Matsuhashi N, Osada S, Yamaguchi K, Saito S, Okumura N, Tanaka Y, Nonaka K, Tkahashi T, Yoshida K (2013) Oncologic outcomes of laparoscopic gastrectomy: a single-center safety and feasibility study. Surg Endosc 27:1973–1979

    Article  Google Scholar 

Download references

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Osaka International Cancer Institute, Otemae 3-1-69, Chuo-ku, Osaka, 541-8567, Japan

    Yoshitomo Yanagimoto, Takeshi Omori, Yoshiyuki Fujiwara, Koichi Demura, Moon Jeong-Ho, Naoki Shinno, Kazuyoshi Yamamoto, Keijiro Sugimura, Hiroshi Miyata, Hajime Ushigome, Yusuke Takahashi, Junichi Nishimura, Masayoshi Yasui, Kei Asukai, Daisaku Yamada, Hiroshi Wada, Hidenori Takahashi, Masayuki Ohue, Masahiko Yano & Masato Sakon

  2. Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Tottori, Japan

    Yoshiyuki Fujiwara

  3. Department of Surgery, Rinku General Medical Center, Osaka, Japan

    Koichi Demura

  4. Department of Surgery, NTT West Osaka Hospital, Osaka, Japan

    Moon Jeong-Ho

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  1. Yoshitomo Yanagimoto
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  2. Takeshi Omori
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  20. Masato Sakon
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Corresponding author

Correspondence to Takeshi Omori.

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Disclosures

Dr. Yanagimoto, Omori, Fujiwara, Demura, Jeong-Ho, Shinno, Yamamoto, Sugimura, Miyata, Ushigome, Takahashi, Nishimura, Yasui, Asukai, Yamada, Wada, Takahashi, Ohue, Yano, and Sakon have no conflicts of interest or financial ties to disclose.

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Yanagimoto, Y., Omori, T., Fujiwara, Y. et al. Comparison of the intracorporeal triangular and delta-shaped anastomotic techniques in totally laparoscopic distal gastrectomy for gastric cancer: an analysis with propensity score matching. Surg Endosc 34, 2445–2453 (2020). https://doi.org/10.1007/s00464-019-07025-0

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